DEPARTMENT OF INSURANCE

Affiliations

Name	Blackerby, Shannon	DOIID	596353	NAIC NPN	8020316

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Personal Lines	9/30/2004	2/25/2008
Inactive	Non Resident	Agent	Life	9/30/2004	2/25/2008
Inactive	Non Resident	Agent	Health	9/30/2004	2/25/2008
Inactive	Non Resident	Agent	Casualty	9/30/2004	2/25/2008
Inactive	Non Resident	Agent	Property	9/30/2004	2/25/2008
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	12/28/2005	2/15/2007
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	12/28/2005	2/15/2007
Inactive	Auto-Owners Insurance Company	301480	Agent - Casualty	12/6/2004	8/20/2007
Inactive	Auto-Owners Insurance Company	301480	Agent - Property	12/6/2004	8/20/2007
Inactive	Auto-Owners Life Insurance Company	301368	Agent - Health	12/6/2004	1/17/2007
Inactive	Auto-Owners Life Insurance Company	301368	Agent - Life	12/6/2004	1/17/2007
Inactive	Banner Life Insurance Company	301696	Agent - Life	4/13/2005	2/25/2008
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	2/26/2007	2/25/2008
Inactive	First Colony Life Insurance Company	301179	Agent - Life	9/30/2005	1/1/2007
Inactive	Genworth Life and Annuity Insurance Company	301276	Agent - Life	1/1/2007	12/4/2007
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	8/29/2005	2/25/2008
Inactive	Humana Insurance Company	301104	Agent - Health	8/30/2005	2/25/2008
Inactive	Humana Insurance Company	301104	Agent - Life	8/30/2005	2/25/2008
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	7/15/2005	2/25/2008
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	7/15/2005	2/25/2008
Inactive	Owners Insurance Company	300796	Agent - Casualty	12/6/2004	8/20/2007
Inactive	Owners Insurance Company	300796	Agent - Property	12/6/2004	8/20/2007
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	3/2/2006	2/25/2008
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	3/2/2006	2/25/2008
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	3/2/2006	2/25/2008
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	3/2/2006	2/25/2008

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Home Ins Agency - Tell Cty Inc	610652	Agent - Casualty	7/25/2005	8/20/2007
Inactive	Home Ins Agency - Tell Cty Inc	610652	Agent - Health	7/25/2005	2/25/2008
Inactive	Home Ins Agency - Tell Cty Inc	610652	Agent - Life	7/25/2005	2/25/2008
Inactive	Home Ins Agency - Tell Cty Inc	610652	Agent - Property	7/25/2005	8/20/2007